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[Editorial] GLOBOCAN 2018: counting the toll of cancer

Sa, 22/09/2018 - 00:00
On Sept 12, the International Agency for Research on Cancer published the GLOBOCAN 2018 estimates of worldwide incidence and mortality for 36 cancers and cancer overall. Behind the data, gathered from local registries representing 185 countries, are the stories of 18·1 million people diagnosed with cancer in 2018 and the sorrow of 9·6 million deaths.

[Editorial] NCD Countdown 2030: strengthening accountability

Sa, 22/09/2018 - 00:00
One of the most powerful forces to emerge from the MDG era has been the idea of accountability. At its most elementary level, accountability means holding those with responsibility for health accountable for their commitments. It is a controversial concept. Few governments wish to be judged by their actions. Global health is replete with pledges, agreements, and declarations guaranteeing outcomes. A Marshall Plan for west Africa after Ebola? Financial assistance to deliver universal health coverage? Scaling up human resources for health? Empty promises.

[Editorial] Monkeypox contacts: a puzzling problem

Sa, 22/09/2018 - 00:00
When it emerged that two people infected with monkeypox had travelled by plane through one of the world's busiest airports, a media storm arose, with irresponsible headlines and exaggerations of risks for others in the UK and across the globe.

[Comment] Partnerships with the alcohol industry at the expense of public health

Sa, 22/09/2018 - 00:00
Public Health England (PHE) and Drinkaware launched the Drink Free Days campaign on Sept 10, 2018.1 PHE's partnership with the alcohol industry-funded body Drinkaware attracted widespread criticism before the launch when 46 public health professionals called for it to be halted.2 When this call was ignored, PHE's alcohol adviser, Sir Ian Gilmore, resigned from this role. In his capacity as chair of the Alcohol Health Alliance, Gilmore said that the partnership was “more likely to improve the reputation of global alcohol corporations than improve the health of the nation”.

[Comment] The Lancet Commission on public policy and health in the Trump era

Sa, 22/09/2018 - 00:00
Amid the raging US Civil War, Abraham Lincoln, the nation's 16th President, vowed that America's “government of the people, by the people, for the people, shall not perish from the earth”. At a time of deep ideological and political schism, it was a notion of government predicated on promoting the welfare—and wellbeing—of its citizens. With the 45th presidency of Donald Trump, that foundational vision has come under siege and the US Government and its commitments are at risk of capture by a privileged few for private gain.

[Comment] Offline: The death and rebirth of globalism

Sa, 22/09/2018 - 00:00
In a restaurant in Beijing, opposite a doctor unusually forthcoming, the conversation turned to the war—the trade war—between America and China. My companion jabbed his finger at me. “Would you really want less America in the world? Tell me from your heart!”, he asked. “Would you really want to live in a Communist country? Tell me from your heart!” His questions were not intended to be politically provocative. He was making a simple point: that the war between China and America was not about trade.

[World Report] India launches Ayushman Bharat's secondary care component

Sa, 22/09/2018 - 00:00
With one of the two crucial components of the Ayushman Bharat nearing a formal launch, can the health reforms transform India's health-care system? Patralekha Chatterjee reports.

[World Report] Forum on China-Africa Cooperation: what it means for health

Sa, 22/09/2018 - 00:00
Investment in health is an essential component of the FOCAC. Whereas some laud China's investment strategy, others deplore that gains to health are hard to track. Andrew Green reports.

[World Report] Increase of West Nile virus cases in Europe for 2018

Sa, 22/09/2018 - 00:00
Hundreds more cases of West Nile virus have been recorded in Europe this year compared with the 2017 season, which experts think might be a consequence of the hot summer. Talha Burki reports.

[Perspectives] Natasha Azzopardi-Muscat: promoting public health in Malta

Sa, 22/09/2018 - 00:00
Promoting public health in a small island nation such as Malta can be extremely challenging, but it is the career that Natasha Azzopardi-Muscat, President of the European Public Health Association and a senior lecturer on health services management at the University of Malta, has negotiated in the past 20 years, working to transform the country's health system to be fit for the 21st century.

[Perspectives] Women in medicine: deeds not words

Sa, 22/09/2018 - 00:00
As a neurology registrar, I worked in a department that ran social events that were exclusively for men. Male doctors were invited to golf outings, while female doctors stayed at work. Somebody had to hold the fort, after all. Cricket matches were more inclusive. Women could attend, but only to make the tea, not to play. This took place in 2003 in one of the UK's foremost centres for neuroscience. I think of it any time I am faced with claims that women have equal opportunities to men in medicine and that any failure to achieve senior positions is out of a lifestyle choice.

[Perspectives] The Royal College of Physicians at 500 years: changing roles and challenges

Sa, 22/09/2018 - 00:00
The Royal College of Physicians (RCP) celebrates its 500th anniversary on Sept 23, 2018. Few organisations have been in continual existence for longer in the field of medicine and to be able to celebrate a quincentenary is a remarkable achievement. Over 500 years, the RCP has assumed different functions as a consequence of the many changes in British sociopolitical history and British medicine. Here, we reflect on some of these changing roles and challenges to the current roles of the College.

[Obituary] Robert Gabriel Newman

Sa, 22/09/2018 - 00:00
Leading proponent of methadone for addiction. He was born in The Hague, the Netherlands, on Oct 26, 1937, and died aged 80 years on Aug 1, 2018, following a traffic accident in New York, NY, USA.

[Correspondence] Iran's hepatitis elimination programme is under threat

Sa, 22/09/2018 - 00:00
On May 8, 2018, the USA withdrew from the Iran nuclear deal and re-imposed a list of sanctions that target Iran's economy and companies from third-party countries that continue to trade with Iran. Both US and non-US business partners have been winding down their economic activities in Iran. These sanctions will have a detrimental effect on the country's viral hepatitis elimination programme.

[Correspondence] Network meta-analysis of antidepressants

Sa, 22/09/2018 - 00:00
In their network meta-analysis of 21 antidepressant drugs for the acute treatment of major depressive disorder in adults (April 7, p 1357), Andrea Cipriani and colleagues1 show that there is a statistically significant difference between drug and placebo, much in agreement with the results of previous systematic reviews.2,3 The crucial question is whether this difference has any clinical relevance.

[Correspondence] Network meta-analysis of antidepressants

Sa, 22/09/2018 - 00:00
It might be naive to draw conclusions about the effectiveness of antidepressants from the meta-analysis of trials, published and some unpublished, by Andrea Cipriani and colleagues.1 The null hypothesis to disprove is that the effect of antidepressants, as a drug class, is no different from that of placebo. Less than half of antidepressants trials submitted to the US Food and Drug Administration (FDA) are positive;2,3 many more negative trials are not submitted.

[Correspondence] Network meta-analysis of antidepressants

Sa, 22/09/2018 - 00:00
Cipriani and colleagues1 confirm previous findings of a small effect of antidepressants over placebo for depression; however, there are some limitations to their assessment of risk of bias and the classification of included trials.

[Correspondence] Network meta-analysis of antidepressants

Sa, 22/09/2018 - 00:00
One result in the network meta-analysis of 21 antidepressant drugs by Andrea Cipriani and colleagues1 conflicts with a 2017 Cochrane review2 of vortioxetine for depression.

[Correspondence] Network meta-analysis of antidepressants

Sa, 22/09/2018 - 00:00
Cipriani and colleagues1 used re-sponse rate (a reduction of ≥50% of the total score) and dropout rate as their primary outcomes. The use of ranking scales for response rates is a misleading way to analyse data,2 which can inflate small differences between groups.3 The effect on the ranking scales was only a standardised mean difference of 0·30 (95% credible interval 0·26–0·34), which is far less than what is clinically relevant4 and is similar to the estimates reported in previous meta-analyses.

[Correspondence] Network meta-analysis of antidepressants – Authors' reply

Sa, 22/09/2018 - 00:00
We agree with Kirsch and Jakobsen that the standardised mean difference (SMD) of antidepressants is, on average, 0·30. Many other medical interventions have similar effect sizes.1 Indeed, the minimal important change for 17-item Hamilton Depression Rating Scale (HAMD-17) is between 4 and 10.2 However, the minimal important change, a within-person index, should not be confused with the smallest worthwhile difference,3 a between-intervention measure that is intervention-specific and can be much smaller.